REPORT  OF  COMMITTEE 


Hospital  Efficiency, 
Hospital 

Finance  and  Economics 
of  Administration. 


A.  S.  KAVANAGH,  D.D., 

Superintendent  of  The  Methodist  Episcopal  Hospital, 
BROOKLYN,  NEW  YORK  CITY. 


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REPORT  OF  COMMITTEE  ON  HOSPITAL  EFFICI¬ 
ENCY,  HOSPITAL  FINANCE  AND  ECONO¬ 
MICS  OF  ADMINISTRATION. 

By  A.  S.  Kavanagh,  D.D., 


Superintendent  of  The  Methodist  Episcopal  Hospital , 
Brooklyn,  New  York  City. 

Article  2  of  the  Constitution  of  the  Hospital  Associa¬ 
tion  reads:  “The  object  of  this  Association  shall  be  the  pro¬ 
motion  of  economy  and  efficiency  in  Hospital  management. 


The  program  of  this  and  previous  conferences  has  been 
built  around  economy  and  efficiency.  “The  Foundation  of 
Hospital  Efficiency”  is  one  of  the  specific  objects  treated  at 
this  conference,  while  all  the  papers  and  addresses  have  dis¬ 
cussed  some  phase  of  economy  and  efficiency,  I  am  quite 
sure  it  would  be  difficult  to  find  a  more  exact  definition  of 
efficiency  than  that  which  Dr.  Chas.  P.  Emerson  gives  in 
his  article  in  “Hospital  Management,”  when  he  says :  “Size 
is  a  poor  standard  by  which  to  judge  a  hospital.  The  only 
correct  standard  would  be  that  of  efficiency  in  giving  each 
patient  the  individual  care  which  has  case  requires. 

It  is  my  duty  now,  by  appointment  of  our  President,  to 
survey  as  far  as  possible  the  whoL  field  and  make  such  sug¬ 
gestions  as  I  may  deem  wise  in  regard  to  economy  and  effi¬ 
ciency.  I  cannot  claim  any  special  fitness  for  this  task, 
but  “such  as  I  have”  it  is  yours  for  the  work  sake. 


As  I  began  the  task  assigned  me  I  was  very  soon  im¬ 
pressed  by  the  largeness  of  my  subject,  and  wished  for  a 
broader  and  more  exact  knowledge  of  the  interests  involved. 
The  hospitals  embraced  in  the  membership  of  this  organiza¬ 
tion  are  suggestive  of  the  wide  field  which  we  must  con¬ 
sider  Here  are  general  hospitals  for  medical  and  surgical 
diseases;  hospitals  for  throat  and  nose;  for  eye  and  ear; 
orthopedic;  contagious  diseases;  city  hospitals;  and  private 

hospitals. 


B 


Some  of  the  particularly  noteworthy  movements  which 
perhaps  are  worthy  of  special  mention  are  the  battle  against 
the  white  plague,  and  the  increasing  provision  which  is  be¬ 
ing  made  for  those  thus  afflicted.  The  movement  on  foot 
at  Bellevue  for  the  training  of  midwives.  The  growth  of 
Social  Service  work. 

Psychopathic  clinics  are  now  conducted  in  connection 
with  the  Long  Island  State  Hospital,  which  makes  it  pos¬ 
sible  for  a  patient  to  secure  the  best  advice  before  becoming 
actually  insane.  Dr.  Doran  says  that  if  these  clinics  had 
been  started  long  ago  thousands  of  cases  of  insanity  might 
have  been  prevented.  In  Syracuse  the  City  Council  has 
established  a  Psychopathic  Hospital  of  seven  beds  for  treat¬ 
ment  of  incipient  cases. 

New  York  State  has  authorized  work  for  inebriates,  and 
the  mayor  of  New  York  City  has  appointed  a  commission 
to  consider  this  problem. 

We  must  also  note  with  satisfaction  the  increasing  inter¬ 
est  that  is  being  taken  in  the  welfare  of  babies.  Much  of 
this  is  being  done  in  connection  with  our  general  hospitals, 
the  greater  part  by  other  organizations,  or  by  private  enter¬ 
prise.  Perhaps  it  will  not  be  inappropriate  in  this  connec¬ 
tion  to  mention  the  work  of  the  Floating  Hospitals  of  the 
St.  John’s  Guild,  N.Y.,  the  new  Seaside  Hospital,  the  Bos¬ 
ton  Floating  Hospital,  and  the  hospital  work  conducted  by 
the  New  York  Association  for  Improving  the  Condition  of 
the  Poor. 

In  my  judgment,  there  is  scarcely  any  line  of  work  that 
is  worthy  of  more  serious  consideration  than  that  of  crippled 
children.  I  wish  to  give  emphasis  to  this  work  by  a  quota¬ 
tion  from  a  letter  received  from  Miss  C.  A.  Aikens.  She 
writes :  “I  would  think  worthy  of  note  the  establishment  in 
Minnesota  and  Massachusetts  state  hospitals  for  cripped 
children,  thus  making  it  possible  for  every  crippled  child 
to  be  put  into  the  best  condition  for  life,  however  poor  he 


V 


4 


may  be.  New  York  led  the  way  some  year's  ago,  and  Penn¬ 
sylvania  and  Maryland  are  pretty  well  provided  for,  but 
there  is  a  very  great  need  that  many  other  states  should  deal 
as  generously  with  the  crippled  child  as  with  the  deaf  and 
dumb,  or  blind  child.  You  cannot  realize  this  need  if  you 
have  not  come  up  aaginst  it  as  I  did  in  Des  Moines  where  we 
had  not  an  orthopedic  surgeon  in  the  state,  ancl  where,  if 
expert  work  was  to  be  done,  a  surgeon  had  to  be  brought 
from  Chicago  at  great  cost.” 

Perhaps  the  finest  achievement  of  the  year  has  been  the 
splendid  and  successful  fight  of  Dr.  A.  H.  Doty  and  his 
assistants  against  cholera,  which  a  few  months  ago  threat¬ 
ened  this  city.  Every  citizen  has  read  this  story  with  a  sense 
of  pride ;  and  also  with  a  sense  of  shame,  when  they  remem¬ 
ber  the  humiliating  investigation  to  which  the  doctor  was 
subjected  in  his  hour  of  triumph.  Investigations  there  must 
be  for  the  public  good,  but  reckless,  semi-political  attacks 
upon  the  good  name  of  a  public  servant  should  not  be  toler¬ 
ated. 

Now  this  brief  survey  indicates  the  vastness  of  the  hos¬ 
pital  and  kindred  fields.  The  Superintendent  should,  in  a 
measure  at  least,  be  conversant  with  the  entire  field.  This 
leads  me  to  emphasize  the  importance  of  the  literature  of 
the  year  as  an  aid  to  efficiency. 

The  time  was  when,  according  to  the  acknowledgement 
of  our  most  experienced  Superintendents,  they  had  to  blun¬ 
der  along  for  years  while  mastering  the  numerous  duties  of 
their  offices.  While  that  day  has  not  quite  passed  for  many 
of  us,  there  is  not  the  same  excuse  now  that  there  once  was 
for  this  condition  of  things. 

One  book  has  come  from  the  press  during  the  past  year 
which  is  indispensable  for  the  young  superintendent,  and 
not  altogether  devoid  of  profit  for  the  oldest.  I  refer  to 
“Hospital  Management”  brought  out  under  the  direction  of 


5 


that  suggestive  and  sane  writer  upon  all  hospital  matters, 
Miss  Charlotte  A.  Aikens,  and  published  by  W.  B.  Saunders 
&  Co.  The  subjects  treated,  and  the  names  of  the  writers, 
suggest  the  value  of  the  book. 

“The  American  Hospital  Field”  is  treated  by  Dr.  Chas. 
P.  Emerson;  “The  Board  of  Managers  and  their  Responsi¬ 
bilities,”  by  E.  S.  Gilmore ;  “The  Superintendent,”  by  Geo. 
P.  Ludlum;  “The  Medical  Service  of  a  Hospital,”  by  Dr. 
Henry  M.  Hurd ;  etc. 

Then  there  are  other  indispensable  publications  such  as 
“The  International  Hospital  Record;”  “The  Trained  Nurse 
and  Hospital  Review;”  and  “The  Canadian  Nurse  and  Hos¬ 
pital  Review ;”  while  the  annual  proceedings  of  the  Ameri¬ 
can  Hospital  Association  cover  practically  every  phase  of 
hospital  work. 

Scarcely  second  to  these  would  I  place  carefully  written 
reports.  I  do  not  mean  reports  which  are  chiefly  statistical 
tables,  containing  only  the  diseases  that  the  “flesh  is  heir 
to.”  I  mean  reports  which  in  addition  to  the  various  tables 
give  the  actual  history  of  the  year, — the  improvements;  the 
work  done ;  administration,  medical,  surgical  and  nursing. 

I  am  glad  to  acknowledge  my  indebtedness  to  such  re¬ 
ports  in  trying  to  form  and  realize  correct  ideals  in  my  own 
work. 

In  the  next  place  I  wish  to  say  there  can  be  no  economy 
or  efficiency  worth  while  without  careful  and  exact  business 
methods.  It  is  well  known  that  the  public  is  sceptical  of  the 
business  methods  of  charitable  institutions,  both  public  and 
private. 

When  Hon.  Bird  S.  Coler  became  die  first  comptroller 
of  the  united  cities  which  form  Greater  New  York,  he 
changed  the  unbusinesslike  graft  cultivating  method  of  giv¬ 
ing  lump  sums  to  private  institutions,  to  the  per  capita  meth- 


6 


od, — a  change  which  put  some  institutions  out  of  commis¬ 
sion  at  once.  To-day  the  city  authorities  are  scrutinizing 
every  dollar  expended  for  charitable  purposes.  To  this  no 
honorable  institution  should  object. 

As  to  business  methods,  our  private  institutions,  if  pos¬ 
sible,  should  be  in  advance,  rather  than  behind,  public  insti¬ 
tutions.  They  are  supported  by  the  voluntary  gifts  of  the 
public,  and  must  by  their  business  method,  as  well  as  scien¬ 
tific  work,  command  the  respect  and  confidence  of  the  pub¬ 
lic. 

It  was  this  ambition  that  led  this  organization  some  few 
years  ago  to  adopt  the  uniform  method  of  accounting,  which 
originated  with  four  of  our  largest  hospitals  in  this  city. 
Now  the  best  thing  about  this  method  of  accounting  is  not 
that  it  aids  one  in  making  a  comparison  between  hospitals 
engaged  in  the  same  sort  of  work,  or  between  their  own  and 
some  other  hospital.  Sometimes  these  comparisons  have  but 
little  meaning,  because  conditions  are  not  the  same.  The  best 
thing  about  the  system  is  that  it  enables  one  to  make  a  com¬ 
parison  between  their  own  hospital  of  a  few  years  ago  and 
now ;  between  their  income  and  expense  account  of  any 
month,  or  any  year;  with  the  present  month,  or  the  present 
year. 

It  is  the  same  business  spirit  that  prompted  the  organi¬ 
zation  of  the  Central  Purchasing  Agency  in  New  York, 
which  is  of  use  in  standardizing  supplies,  and  which  has  pos¬ 
sibly  secured  better  prices  for  some  articles,  but  which,  more 
than  anything  else,  demonstrated  what  good  terms  the  hos¬ 
pitals  had  secured  when  acting  as  their  own  agent. 

The  same  spirit  should  lead  to  watchfulness  against  the 
loss  of  money  through  the  loss  of  time  (for  time  is  money), 
or  through  the  lapping  of  the  duties  of  employees. 

It  will  be  found  conducive  to  the  efficiency  of  each  de¬ 
partment,  and  of  the  entire  hospital,  and  good  business  as 
well,  to  keep  an  accurate  time  record  of  every  employee  of 


the  hospital.  About  six  months  ago  we  installed  a  time 
clock  by  which  each  employee,  including  the  superintendent, 
supervisor  of  nurses,  and  everybody  down  to  the  scrub¬ 
woman,  is  his  or  her  own  timekeeper,  and  practically  deter¬ 
mines  the  exact  wage  that  he  or  she  will  receive.  The  head 
of  each  department  also  prepares  a  pay-roll  for  their  depart¬ 
ment,  and  if  their  pay-roll  does  not  agree  with  the  time  clock 
cards,  explanations  will  be  in  order.  Thus  the  time  cards 
tone  up  not  only  each  individual  employee,  but  the  depart¬ 
ment  heads  as  well. 

Another  thing  that  will  add  materially  to  the  economical 
management  of  each  department  is  this.  The  superintendent 
should  so  plan  his  work  that  he  can  be  his  own  purchasing 
agent.  Nothing  from  a  box  of  matches  to  an  operating  out¬ 
fit  should  be  ordered  except  over  his  signature.  In  a  large 
institution  this  might  seem  impossible,  but  not  so  if  he  has 
a  good  secretary  who  has  the  business  well  in  hand ;  has  the 
prices  previously  paid ;  lists  of  goods  purchased,  and  where. 

Together  with  the  purchasing  should  be  considered  the 
distribution  of  goods.  In  my  hospital  we  have  requisition 
slips  with  blanks  for  goods  desired,  and  for  the  goods  on 
hand  of  the  same  kind,  and  for  the  goods  delivered.  This 
requisition  slip  is  signed  by  the  head  nurse,  O.K.’d  by  the 
•  supervisor  of  nurses,  and  then  sent  to  the  storekeeper.  When 
returned  to  a  floor  the  head  nurse  signs  for  the  articles  re¬ 
ceived.  Then  the  slip  comes  to  my  office,  where  the  ward  is 
credited  with  the  goods  received.  The  pharmacist  has  a 
similar  method  of  keeping  track  of  medicines.  In  this  way 
we  know  where  the  supplies  are  going. 

As  to  the  financial  loss  which  comes  through  breakage  and 
waste,  I  can  add  but  little  to  what  we  have  heard  many  times. 
I  think  the  plan  adopted  by  many  hospitals  of  insisting  that 
all  broken  or  worn  articles,  crockery,  furniture,  general  and 
treatment  utensils,  must  be  returned  with  requisition  for  a 
new  supply,  is  an  excellent  plan. 


8 


In  order  to  keep  a  close  watch  over  the  waste,  the  plan 
which  we  are  using  is  this.  We  have  six  receptacles  for 
refuse  in  our  crematory  room.  Each  of  these  receives  the 
refuse  of  different  parts  of  the  hospital,  and  is  under  lock 
and  key.  There  is  a  daily  inspection  of  these  receptacles, 
and  if  anything  improper  comes  down  we  know  where  it 
has  come  from,  and  act  accordingly. 

Dr.  H.  T.  Summersgill,  Superintendent  of  the  New 
Haven  Hospital,  writes  along  the  same  line.  He  says:  “I 
have  found  much  waste  can  be  prevented  by  routine  inspec¬ 
tion  of  broken  crockeryware  and  other  articles  which  have 
been  condemned  or  broken.  I  have  a  room  fixed  up.  adja¬ 
cent  to  the  storeroom;  in  there  is  placed  and  labelled  one 
good-sized  barrel  for  each  ward  and  each  department.  A 
hole  six  inches  in  diameter  has  been  cut  in  the  door  so  that 
the  contents  of  these  barrels  can  be  observed  from  the  out¬ 
side.  In  these  barrels  are  placed  the  breakage  from  each 
ward  and  each  department,  the  one  breaking  the  article  be¬ 
ing  obliged  to  put  label  on  it  with  name  and  date.  If  a  nurse 
in  charge  of  a  ward  has  an  unusual  amount  of  breakage  in 
a  month,  she  is  brought  to  account  for  poor  management. 
If,  on  the  contrary,  a  nurse  has  done  very  well  and  been 
careful  in  her  management,  she  receives  proper  credit  for  it. 
All  our  instruments  for  ward  dressings  are  now  sterilized 
by  steam  in  our  operating-room  building  instead  of  the  cus¬ 
tom  in  use  in  most  institutions  where  they  are  sterilized  by 
gas  in  each  ward.” 

Knowing  the  many-sidedness  of  hospital  work,  I  thought 
I  would  like  some  of  my  friends  to  help  me ;  accordingly,  I 
addressed  about  one  hundred  members  of  this  Association, 
asking  them  to  give  their  fellow-workers  the  benefit  of  their 
experience  by  writing  for  this  Round  Table  part  of  my  paper 
any  feature  of  their  work  which  was  particularly  successful 
during  the  past  year.  This  opened  a  wide  door,  as  we  in- 


9 


tended  it  should,  and  I  received  many  exceedingly  suggestive 
replies  which  I  now  bring  to  you  in  this  Round  Table  part 
of  my  paper. 

We  have  been  discussing  business  methods  of  organiza¬ 
tion.  Several  of  my  correspondents  have  something  of  value 
to  say  concerning  this  subject. 

Miss  Louise  C.  Brent,  Superintendent  of  the  Hospital 
for  Sick  Children,  Toronto,  writes:  “One  of  the  successful 
features  that  has  aided  the  efficiency  of  the  hospital  adminis¬ 
tration,  is  that  each  department  has  a  head,  who  is  respon¬ 
sible  to  the  superintendent  for  the  work  of  his,  or  her  de¬ 
partment,  from  the  superintendent  of  nurses  to  the  caretaker 
of  the  building.  This  may  not  be  exactly  a  new  feature,  but 
we  have  found  it  an  entirely  satisfactory  one. 

Dr.  Clarence  E.  Skinner,  of  the  Elm  City  Private  Hospi¬ 
tal,  also  gives  emphasis  to  the  same  fact  which,  he  says, 
“conduces  very  greatly  to  the  efficiency  of  service  and  econ¬ 
omy  of  financial  management.” 

Mrs.  A.  M.  Lawson,  Superintendent  of  the  General 
Memorial  Hospital,  writes :  “The  fact  that  heads  of  our 
departments  report  to  the  superintendent,  and  not  to  com¬ 
mittees,  or  sub-committees,  makes  the  executive  work  run 
more  smoothly.” 

Miss  Nancy  E.  Cadmus,  Superintendent  of  the  Manhat¬ 
tan  Maternity  and  Dispensary,  speaking  of  the  employment 
of  a  resident  physician  and  his  duties,  says :  “He  is  simply 
a  head  of  a  department  the  same  as  the  principal  of  nurses, 
housekeeper,  or  engineer.” 

These  quotations  are  sufficient,  I  think,  to  make  clear  the 
position  of  the  superintendent  in  any  efficient  plan  of  hospi¬ 
tal  organization.  He  is  the  connecting  link  between  the 
board  of  managers  and  each  department  of  the  hospital.  If 
the  board  of  managers  treats  him  with  the  consideration 
that  his  position  should  have,  he  will  be  their  representative 
in  all  details  of  administrative  work. 


10 


From  many  letters  it  is  evident  that  the  nursing  question 
is  still  open  for  discussion. 

Dr.  Renwick  R.  Ross,  Superintendent  of  the  Buffalo 
General  Hospital,  requests  that  we  discuss  the  “special  nurs¬ 
ing  of  private  patients  twelve  or  twenty-four  hour  system.” 
I  suppose  by  right  that  should  go  to  the  question  box,  but 
I  will  say  this.  In  my  hospital  we  have  no  difficulty  with  the 
matter.  When  nurses  are  on  private  duty  outside  the  hospi¬ 
tal  they  frequently  take  twenty-four  hour  cases ;  whether 
in  the  majority  or  minority  of  cases,  I  do  not  know. 

Now  it  is  easier  to  nurse  in  the  hospital  than  outside. 
The  attending  physician  and  supervisor  of  nurses  determine 
whether  the  patient  should  be  a  twelve  or  twenty- four  hour 
case.  The  nurse  that  will  not  take  a  twenty-four  hour  case 
under  these  condition  will  not  be  permitted  to  come  in  and 
take  a  twelve-hour  case. 

Others  write  concerning  the  scarcity  of  nurses,  intimating 
that  herein  is  a  great  hindrance  to  hospital  efficiency,  and 
these  reports  come  from  all  parts  of  the  country.  Here  in 
New  York  the  difficulty  is  felt  with  very  great  keenness.  The 
desire  to  improve  the  quality  of  nursing  by  securing  for  our 
training  schools  reasonably  well-educated  young  women  is 
appreciated  by  every  one  who  has  had  occasion  to  have  a 
trained  nurse  in  his  own  family. 

But  the  Board  of  Education  in  New  York  State,  which 
has  practically  unlimited  powers  under  a  loosely-drawn  State 
law,  has  pushed  matters  so  far  that  the  greater  part  of  the 
hospitals  in  Greater  New  York  City  have  memorialized  the 
Board  of  Regents  of  the  State  protesting  against  the  present 
methods  of  the  Education  Department  in  dealing  with  the 
hospitals  of  the  city. 

If  other  states  are  pressing  matters  as  New  York  State 
is,  it  is  easy  to  understand  the  reason  for  the  shortage  of 
nurses.  The  course  in  this  State  is  legally  two  years,  but 
those  who  prepare  the  curriculum  believe  in  three  years, 


and  in  three  years  only,  and  prepare  the  curriculum  accord¬ 
ing.  Now  it  is  perfectly  evident  that  many  a  girl  falls  out 
in  the  midst  of  her  course  because  of  the  crowding  which  is 
necessary  in  order  to  master  the  various  studies,  even  though 
she  had  three  years  to  complete  them. 

Then  again  the  demand  which  requires  one  year  of  high 
school,  or  its  equivalent,  places  a  premium  upon  the  intel¬ 
lectually  and  physically  unfit.  Girls  who  are  unable  to  pur¬ 
sue  their  studies  beyond  one  year  in  high  school  fail  for  phy¬ 
sical  or  intellectual  reasons.  As  a  rule,  the  grammar  school 
graduate  is  the  equal,  and  in  some  cases  superior  to  the  girl 
with  one  year  of  high  school  to  her  credit. 

It  was  natural  that  superintendents  should  write  concern¬ 
ing  material  improvements. 

Mr.  Asa  Bacon,  Superintendent  of  the  Presbyterian  Hos¬ 
pital,  Chicago,  tells  of  the  expenditure  of  nearly  $800,000  in 
improvements,  and  no  deficiency  for  four  years. 

Dr.  W.  T.  Graham,  Superintendent  of  the  Methodist 
Hospital  in  Indianapolis,  tells  of  the  expenditure  of  $125,000 
in  new  buildings,  and  of  plate  glass  partitions  between  each 
crib. 

The  Beth-El  Hospital,  of  Colorado  Springs,  Miss  Flor¬ 
ence  E.  Standish,  Superintendent,  has  expended  $35,000  in 
the  erection  of  new  buildings.  The  money  was  raised  by 
issuing  six  per  cent,  bonds.  Then  an  agent  was  put  in  the 
field  to  raise  the  money  who  is  meeting  with  success.  I  no¬ 
tice  she  mentions  a  paid  ansethetist. 

Mrs.  Jennie  E.  Bassett,  Superintendent  of  New  Britain 
General  Hospital,  writes  of  a  new  operating  building  costing 
$25,000,  and  of  plans  for  a  new  private  building.  She  asks : 
“Will  some  one  kindly  tell  me  the  best  finish  for  hospital 
floors;  and  how  to  prevent  the  awful  waste  of  food  from 
patients’  trays  ?”  I  have  read  Mrs.  Bassett’s  question  chiefly 
because  it  illustrates  for  all  of  us  the  first  essentials  to  ef¬ 
ficiency — to  detect  and  feel  keenly  the  need  of  improvement. 


12 


The  New  York  Hospital,  Dr.  Thos.  Howell,  Superintend¬ 
ent;  The  New  York  Society  for  the  Relief  of  the  Ruptured 
and  Crippled,  Mr.  Oliver  H.  Bartine,  Superintendent;  The 
Presbyterian  Hospital,  are  about  to  change  their  locations, 
and  are  planning  for  even  larger  things  in  the  future  than 
in  the  past. 

The  New  York  Post-Graduate  School  and  Hospital,  Dr. 
Fred  Brush,  Superintendent,  is  bringing  to  completion  build¬ 
ings  which  will  increase  their  bed  capacity  from  200  to  400. 

The  Methodist  Episcopal  Hospital,  in  Brooklyn,  N.Y., 
has  recently  spent  $100,000  in  improvements. 

The  Indianapolis  City  Hospital,  Dr.  J.  L.  Freeland,  Su¬ 
perintendent,  is  rejoicing  over  Si  10,000  received  from  the 
city  for  new  buildings.  He  also  reports  a  legacy  of  $225,- 
000,  and  confesses  to  inside  information  as  to  $700,000  mbre 
coming  from  a  living  donor. 

There  are  only  two  things  better  than  legacies — a  gift 
during  one’s  lifetime,  so  that  he  can  have  the  pleasure  of 
seeing  it  at  wo^k ;  or  a  gift  upon  which  the  hospital  may  pay 
a  moderate  annuity  during  the  life  time  of  the  donor. 
Either  of  these  methods  will  defeat  the  purpose  of  the  legacy 
chaser — for  there  are  legacy  chasers  as  well  as  ambulance 
chasers. 

The  Rev.  Geo.  F.  Clover,  Superintendent  of  St.  Luke’s 
Hospital,  this  city,  tells  us  of  the  appointment  ot  nurses  as 
anaesthetists  at  his  hospital,  and  he  adds:  “We  have  gone 
far  enough  to  feel  that  it  is  a  step  in  the  right  direction.” 

They  have  also  set  apart  a  special  building  for  the  hous¬ 
ing  of  the  help  in  which  each  person  has  a  small  room.  This 
arrangement  gives  satisfaction  to  a  majority  of  the  servants. 
“But,”  he  states,  “we  have  found,  however,  a  few  servants 
who  felt  so  lonely  and  fearful  over  going  to  single  rooms 
that  they  put  in  a  request  that  they  might  be  allowed  to  re¬ 
turn  to  club  rooms  with  several  other  servants.” 


13 


Concerning  floors  he  writes,  and  this  may  be  of  interest 
to  Mrs.  Bassett  and  others :  “A  combination  tile  and  linol¬ 
eum  floor  which  I  laid  nearly  a  year  ago  has  proven  to  be 
quite  excellent,  and  it  appeals  to  me  as  rather  the  best  thing 
yet  done'  in  the  way  of  flooring.” 

Dr.  Wm.  O.  Mann,  Superintendent  of  Massachusetts 
Homoepathic  Hospital^  Boston,  tells  of  a  new  $150,000  build¬ 
ing  for  Clinical  Research  and  Preventive  Medicine.  In  this 
building  there  will  be  an  auditorium  for  public  lectures  along 
the  lines  of  preventive  medicine.  This,  perhaps,  might  be 
considered  unique  in  hospital  work. 

Miss  Mary  H.  Riddle,  Superintendent  of  Newton  Hos¬ 
pital,  Newton,  Mass.,  writes :  “This  is  one  of  the  hospitals 
in  which  both  schools  of  medicine  practice  without  friction.” 
Perhaps  that  might  be  a  good  cure  for  hospital  friction.” 

Under  the  by-laws  of  the  Methodist  Hospital  in  Brooklyn 
all  schools  can  treat  their  patients  in  our  private  beds.  To 
treat  surgical  cases,  it  is  necessary  that  outside  physicians 
must  be  on  the  surgical  staff  of  some  reputable  hospital. 

Dr.  A.  W.  Smith,  Superintendent  of  Hartford  Hospital, 
Hartford,  Conn.,  writes:  “We  allow  our  staff  or  any  le- 
putable  physician  to  send  in  cases  to  private  rooms  and  take 
care  of  them.” 

Mr.  Reuben  O’Brien,  Superintendent  of  the  Manhattan 
Eye  and  Ear  Hospital,  says  that  nothing  adds  to  hospital  ef¬ 
ficiency  like  an  experienced  woman  in  charge  of  the  kitchen. 

Miss  Margaret  Moran,  Superintendent  of  the  Macon 
Hospital,  Macon,  Ga.,  writes  concerning  the  success  of  the 
newly  installed  signal  light  system.  ^\ny  system  that  will 
do  away  with  noisy  call  bells  will  soon  find  its  way  into  all 
of  our  hospitals. 

Dr.  C.  I.  Fisher,  Superintendent  of  the  Presbyterian  Hos¬ 
pital  in  this  city,  writes  a  most  valuable  letter  concerning  the 
relation  of  the  Superintendent  to  the  House  Staff  in  regard 
to  their  relations  to  patients  outside  strictly  professional  mat- 


14 


ters.  He  says:  “For  many  years  I  have  taken  note  of  the 
various  incidents,  accidents,  etc.,  which  have  brought  dis¬ 
credit  to  the  hospital  through  the  attitude  and  behavior  of 
the  House  Physician  and  Surgeons.  As  soon  as  we  have 
graduated  our  House  Physicians  and  Surgeons  and  the 
seniors  come  to  take  their  places,  I  get  these  men  together 
and  tell  them  about  these  things  which  have  happened,  how 
they  discredit  the  hospital,  and  how  they  could  and  should 
have  been  handled  differently. 

The  ambulance  men  have,  through  ignorance  and  some¬ 
times  over-confidence  and  lack  of  tact,  caused  us  consider¬ 
able  trouble.  I  get  these  men  together  of  an  evening  and 
tell  them  all  the  things  that  have  happened,  what  surprises 
are  likely  to  come  to  them,  and  show  them  how  tliey  can 
handle  these  and  bring  credit  rather  than  discredit  to  the 
hospital. 

The  men  who  examine  patients  for  admission  to  the 
hospital,  have  in  themselves  great  possibilities  for  good  or 
evil,  particularly  evil.  I  have  an  evening  with  these  men, 
and  tell  them  the'  things  that  have  happened,  and  along 
what  ilnes  there  are  peculiar  dangers  in  admitting  or  not  ad¬ 
mitting  certain  classes  of  cases.  We  have  a  good  talk  to¬ 
gether,  perfectly  informal,  and  they  ask  me  questions.  I  am 
sure  that  in  these  talks,  I  have  saved  the  hospital  a  great 
deal,  and  prevented  things  happening  which  would  have 
been  exceedingly  unpleasant. 

I  endeavor  to  accomplish  similar  things  with  our  nurses, 
though  not  in  quite  the  same  way. 

There  is  another  question  to  which  I  would  invite  your 
attention.  Dr.  Fisher  presented  a  paper  on  a  very  practical 
subject  last  year  at  St.  Louis,  and  it  seems  to  me  we  should 
not  allow  it  to  be  forgotten.  He  made  a  plea  for  more  ample 
provision  for  the  great  middle  class  who  are  neither  rich 
nor  poor.  They  do  not  wish  charity,  neither  can  they  afford 
luxurious  accommodation,  nor  large  surgical  fees 


Here,  however,  is  a  danger :  v/hile  the  hospital  may  plan 
for  this  class  of  patients  even  at  a  loss,  yet  the  surgeons’ 
fee  may  be  just  as  large  as  if  the  patient  was  cared  for  in 
a  private  room  with  a  single  bed.  Indeed  the  fee  may  be 
larger  because  of  reduced  hospital  charges. 

Dr.  Fisher  well  said  that  “it  will  be  necessary  to  place 
about  it  such  regulations  as  will  safeguard  it  from  any  ef¬ 
fort  of  the  parsimonious  rich  to  obtain  use  of  these  rooms, 
or  of  attending  physicians  or  surgeons  to  put  into  them  those 
wealthy  patients  who  should  pay  the  price  of  the  more  ex¬ 
pensive  service.”  The  fees  for  these  rooms  should  be  very 
moderate  and  definitely  fixed. 

I  think  there  has  been  no  more  practical  deliverance  than 
this  for  some  time.  And  it  seems  to  me  that  the  matter 
should  not  be  allowed  to  stop  there.  I  wish  that  it  might 
be  taken  up  by  our  hospital  journals  and  discussed,  and 
that  our  superintendents  might  be  prevailed  upon  to  report 
through  these  journals  their  plans  for  the  care  of  this  class 
of  patients,  rates,  fees,  etc. 

In  bringing  this  paper  to  a  conclusion  permit  me  to  con¬ 
gratulate  the  committee  on  the  non-commercial  hospital  ex¬ 
hibit,  on  the  excellent  display  which  they  have  made,  which 
I  am  quite  sure  will  be  conducive  to  economy  and  efficiency 
of  hospital  administration. 

President:  I  am  sure  we  are  all  very  grateful  to  Dr. 
Kavanagh  for  his  excellent  resume  of  the  work  of  the  year 
in  the  different  hospitals  of  the  country.  To  me  it  has  been 
very  illuminating. 


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